Central venous catheters are essential to the management of the hospitalized patient, especially when critically ill, but catheters do result in substantial morbidity, mortality and expense. Infectious complications alone are responsible for as many as 70,000 deaths annually with an estimated cost to the healthcare system projected at over $2 billion. Large, randomized controlled trials are currently lacking for the majority of interventions considered standard for diagnosis and treatment of catheter related infection (CRI). The proposed research project will pool the best available published evidence for diagnostic accuracy and management of catheter related infection (Aims I & 2), perform a case-control study to examine the economics associated with infection (Aim 3) and lastly, synthesize all of these data elements into a decision analysis model to examine the risks, benefits and costs associated with alternative diagnostic and management strategies (Aim 4). The results of this study are expected to provide a rational, cost effective approach to catheter management decisions in the ICU and could help to identify critical data or strategies that should be examined in future clinical trials.